SCHOOLS DIVISION OFFICE OF PANGASINAN II

APPLICATION OF LEARNING AND DEVELOPMENT

A. Background Information

Name
Region/Division/District
Name of School
L & D Engagement/Course
Key changes in my
school/classroom as a result
of this application project

What key changes do you want

to see in your school as a result
of your having attended the
SLDP? What are your specific,
verifiable indicators of these
changes?
Target Competency
Improvement

What school head or teacher

competency/ies will you apply
through your project. Identify
maximum of three that are
directly related to your project.
Describe current situation
(problem or opportunity) in
your school/classroom that
you need to address through
your project

Give specific, quantifiable,

observable details. For example,
number of struggling readers in
Grade 1. Or, number of teachers
that need training by a certain
period. Or, timely utilization of
MOOE.
Title of Application Project
Project Objectives To:

Must be SMART – Specific,

Measurable, Attainable, Result-
oriented and Time-bounded

Address: Canarvacanan, Binalonan, Pangasinan 2436

Telephone Number: 524-7295 Email: hrd.pangasinan2@deped.gov.ph
 Start Date
Length of Project
The project should be completed
within 3 to 6 months
Expected Outputs
Beneficiary/ies
Identify Success Indicators or This project will be a success when the
measures of success following indicators have been achieved and
verified through unbiased means (maximum of
3)

B. Action Steps
Identify significant Milestone targets that could be achieved by the end of 30 days
and every 30 days thereafter. Milestones are (a) significant changes achieved;
and/or, (b) major steps taken towards achieving the desired improvement in your
school

Target Actions Responsible Support Target Date

Milestone Person Needed When will this
Who will do from: step be
this step? accomplished
?
Milestone 1 Action Step 1
Action Step 2
Action Step 3
Etc.
Milestone 2 Action Step 1

Milestone 3 Action Step 1

Etc

C. Required Resources
Provide Specific Details of the physical and human resources required to
successfully implement your Application Project. Aps that have funding
requirements may be funded by local funds (school, division, region) in
coordination with the respective head of office.

Milestone Resources Budget Approvals

Needed Needed

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D. Risk Management Plan
All projects are exposed to risk. Risk are unpredictable events that might or might
not happen and endanger the achievement of your project objectives. You should
therefore know what risks to prioritize and what to do when the risk happens.

Milestone Likely Risk Impact on Specific If Risk

Project if Action to Happens,
Risk Happens Prevent Risk Specific
Action to
Soften
Impact of
Risk

Prepared by:

NAME
Position
Signature

Noted:

________________________ _____________________________
School Head PSDS
NOTE: Signatories for Approving Authority
Verified and Validated: For 6TH:
WILFREDO E. SINDAYEN, EdD
JANICE M. RIVERA, PhD Assistant Schools Division Superintendent
Senior Education Program Specialist - HRD For 4TH and 5TH:
ROSARIO O. CABRERA
Assistant Schools Division Superintendent
RECOMMENDING APPROVAL:

CORNELIO R. AQUINO, EdD REDENTOR B. AQUINO, PhD

Chief Education Supervisor, CID Chief Education Supervisor, SGOD

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APPROVED FOR THE SCHOOLS DIVISION SUPERINTENDENT:
_______________________________________
Assistant Schools Division Superintendent

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